Bismuth Nephropathy

ACCIDENTAL poisoning is a major health hazard and a major cause of mortality among children. Although we are frequently reminded of the increasing complexity of our environment and the growing list of toxic materials available to children for ingestion, few physicians are aware that bismuth salts continue to be marketed and remain among the uncommon yet important causes of poisoning. In the last 45 years there have been numerous reports^1-12 of toxic effects of bismuth which was once a widely used drug in the treatment of syphilis.¹³ One of the several current forms of bismuth, bismuth sodium triglycollamate (Bistrimate), is marketed as an oral therapy for the verruca vulgaris, the common wart, and other dermatoses. Several current textbooks of dermatology recommend this therapy even though there is evidence that bismuth is ineffective as therapy for verrucae.¹⁴ Since the drug is available, is prescribed, and is thus a